ES2255667T3 - ORTHOPEDIC SUPPORT FOR ARM AND SHOULDER. - Google Patents

Abstract

A programmable motor connected to brace, controls the movement of the distal end of the limb at different points.

Description

Orthopedic support for arm and shoulder.

The present invention relates to a harness portable orthopedic for arm and shoulder that provides a continuous passive movement of a user's shoulder, as well as to methods to operate and design an orthopedic arm and a harness this class.

Background of the invention

The shoulder is a joint of the human body relatively complex, has various degrees of freedom and ranges between a linear movement and especially an angular movement, that is, abduction, flexion and rotation. One shoulder treatment after an injury or surgical trauma normally requires immobilization of the shoulder and arm attached to it, during a prolonged period of time

To immobilize and support an injured shoulder type healing devices have been presented during the healing process Clipboard. US 4,896,660 describes a support device for a arm comprising an upper arm support, a fixation configured for the shoulder and a lower arm support. He upper arm support is operable to stop against a patient's flank and is below the humeral part of the patient's arm. The configured shoulder fixation comprises a configured shirt part and two bands that so detachable attach the shoulder fixation to the upper arm support. The lower arm support joins the support structure upper arm and provides support for a forearm and a Patient's hand FR 2,727,007 describes a cushion structure inflatable provided with different positioning means, which apply between the chest and the upper arm of the patient. FR 2,589,722 and US 5,423,333 describe a device for immobilizing a human shoulder and to support the wrist of the arm associated with that  shoulder, which comprises three inflatable bladders joined together to form a triangular wedge. The wedge is located under the arm of the patient so that a bladder is placed along the flank of the patient, and so that his arm rests on another of the bladders The device is designed so that the arm of the patient remains at a fixed angle in relation to the thorax. The angle between the arm and the chest support is variable, in function of the possibility of folding one of the wedge bladders triangular. US 5,236,411 refers to a device for immobilize a patient's limb in an elevated position that comprises an inflatable element that can be adjusted between a state defined and a swollen state and a harness to hold the device to the patient's body. The element is placed between a support surface and the patient's limb, thus raising the end.

However, although the devices above described are suitable to immobilize a shoulder, what they do is immobilize the shoulder in essentially a position against the body: the arm is immobilized according to a certain angle with relation to the thorax and no other arm movement is allowed. Also, those devices do not allow the supported arm and the shoulder perform combined movements, which is useful for the effective reinforcement of the arm and shoulder muscles after injury or surgical operations.

Indeed, it has been seen that rehabilitation effective requires the recovery of movement margins angular arm and shoulder. A certain degree of mobility of the patient's limbs so as not to leave the Shoulder out of rehab. In view of that need, they have developed devices that allow passive movement continued arm and shoulder of the patient, of which EP 0.597.623 and EP 0.525.930 can be cited as examples.

EP 0.597.623 refers to an adjustable support for the shoulder, mountable on the arm and torso to isolate the shoulder and that is fully adjustable across the margins of abduction, flexion and rotation of the shoulder, so that it allows shoulder fixation in virtually any position of rehabilitation. The support is made of a series of elements of rigid support attached to the patient's body, and a plurality of selectively rotating and interlocking joints that interconnect tightly the support elements. It is said that the effect combined of the joints simulates the entire range of motion of the shoulder. However, due to the presence of a plurality of joints to position the shoulder at chosen angles of abduction, flexion and rotation, the device is very complicated, uncomfortable and hard to adjust Also, that device immobilizes the shoulder of the patient with a certain angle.

EP 525,930 refers to a passive exerciser of the shoulder built to move the patient's arm forward and backward at a 180 degree angle to provide flexion and shoulder abduction. The exerciser comprises a base, an engine electric drive, and a support for the patient's arm, mounted with the motor driven for alternative movement by means of the drive motor according to a 180 degree arc. He arm support is mounted sliding and articulated, so that during the use of the exerciser the patient's arm can slide approaching and separating from the body and articulate along two points of articulation to allow the shoulder joint follow a natural anatomical form of movement. However that Device type does not allow all essential movements, among them the combined movements of wrist and elbow. Also that device is bulky and impractical. As it is not a portable device, the patient has to move to the place of exercise and rehabilitation device every time you want to use of the same.

In US 4,651,719 another device is described humeral intended to impart a continuous passive movement to the shoulder of a patient A portable arm and shoulder support produces abduction and adduction and has the option of causing a simultaneous rotation through the use of a single actuator. A upper arm support is articulated and extends laterally from the base of the device. An actuator linear extends between the upper arm support and is linked with it, and the basis, to give rise to abduction and adduction arm. A support for the forearm, attached articulated to the upper arm support and adjustable angularly with respect to it is linked to the base for produce the rotation of the forearm support when the upper arm support. The device is hosted in a envelope that forms a chamber with an extendable cover and in two parts, so that the functional mechanism is hidden. Without However, although it is portable, this device is rather bulky And it can be awkward.

Many of the above systems present also the disadvantage of sliding out of the body, slipping to the back of the user, which recently Practical in their employment.

Currently known devices suffer of several inconveniences. The need for a support persists Compact and comfortable orthopedic that allows all kinds of movements passive, simple and combined, of the supported limb.

Summary of the Invention

It is an object of the present invention provide a body harness that provides passive movement continuous and overcome the inconveniences of the devices currently  known, as well as a method to operate and design such harness

It is also an object of the invention to provide an autonomous device suitable for application to a limb and that is capable of performing a certain number of different passive movements of the limb in an automated and
controlled.

It is also the subject of the present invention. have a suitable device to apply to a limb and that allows simple as well as combined movements of the end.

Another object of the invention consists in provide a harness for a limb that is compact, easy to use and comfortable when mounted on a patient's body, even for prolonged periods of time.

Another object of the present invention is provide a harness that increases the patient's ability to move.

Another object of the present invention is still provide a harness that represents a combination of objects previous.

The invention is especially suitable in the Paramedic and orthopedic applications field. In particular, The invention can be used for the rehabilitation of all kinds of injuries, especially those of shoulders.

The invention relates to a portable device appropriate to provide a continuous passive movement of a limb, which comprises a harness to support a distal end of the member, a drive mechanism to provide a continuously adjustable passive movement of the member being the drive mechanism (mechanically) coupled to the harness that controls the movement of the distal end of the member, characterized because the passive movement is independently controlled by a first movement control point on the distal end and a second movement control point on the distal end of the member, and because the drive mechanism comprises at least a first unit to control the movement of the first point of motion control of the distal end of the limb. He portable device further comprises a second unit for control the movement of the second control point (of movement) of the distal end of the limb. In another embodiment, the device portable comprises means to immobilize the second point of control of the distal end of the limb.

The portable device may also have means flexible positioners arranged with clamping means that place the harness and drive mechanism on the body of a patient bringing the device to a stable position, in which the drive mechanism is, at least in part, housed within The positioning means.

The drive mechanism to communicate a continuous passive movement adjustable to the member can be a motor programmable.

In another embodiment, the harness comprises a support for the distal part of the member comprising a first primary subframe to support the distal end of the member, a support of the proximal end of the member that comprises a second primary subframe for support the proximal end of the limb, and a joint to attach the distal end support to the proximal end support of the member.

The portable device may have a harness that comprise a secondary subframe attached to the first primary subframe of the distal end of the limb through a mechanical interface, linking the secondary sub-frame the first control point of movement with the second movement control point. Further, the mechanical interface is arranged near a joint between the end distal and the proximal end of the limb and joining the sub-frame secondary to primary sub-frame of the distal end of the member.

The portable device may also comprise positioning means having an inflatable housing made of a flexible material provided with fastening means, allowing the housing a at least partial deformation when subjected to a body to provide a stable position. The supports for the distal end and the proximal end of the member can be provided of member bras, which may have bands of fixation. The lower arm support can also be adjustable in order to adapt the length of the distal end of the member of the user.

The first and second motor units can consist of a triple axle with electric motor equipped with spindle wheel transfer, being arranged in a housing that allows motor units to induce a virtually vertical movement.

The mechanical interface may be provided with a sliding mechanism driven by a motor, allowing the mechanism the support of the distal end of the member to perform a sliding movement

The positioning means may comprise also bolts provided with fasteners, to position the device On a human body. Passive movements made by the device can be controlled with a remote control unit, which can have control bodies and a presentation screen visual.

Two connectors can be arranged on the side upper of the positioning means, in which a connector joins the remote control unit and the other connector is connected to a Electric transformer or one or more batteries.

The portable device can perform passive movements of the member in an automated way.

In an alternative embodiment, the points of control are attached to the positioning means, e.g., by springs Thus, the member's active movements are limited due to the presence of springs. This could be advantageous, e.g., to train a member, avoiding injuries due to excessive movement.

The invention relates to a portable device suitable to provide a continuous passive movement of a member, in which the device comprises a harness to support a distal end of the limb, a drive mechanism for provide a continuous and adjustable passive movement to the member, the drive mechanism being (mechanically) coupled to the harness at least a first and second control points to control the movement of the distal end of the limb, characterized in that the drive mechanism comprises means for provide at least adduction and abduction movements of the limb and rotational movements around at least the First or second control points.

The present invention provides a device able to communicate different passive movements originated by a One member engine. The presence of a motor mechanism programmable on the device allows a supporting member to harness perform passive movements in an automated way and controlled. The programmable motor mechanism comprises several units, which induce vertical or sliding movements. Because its ability to induce various types of movements, the device according to the invention is especially suitable for providing simple or combined movements of the member. Surprisingly although a patient's member is effectively supported and immobilized in the device according to the invention, the member can still perform passive movements, simple and also combined, such movements being recommended for effective rehabilitation of the injured member.

Importantly, the device according to the invention is highly comfortable, since it is portable, lightweight and easy to apply. In addition, the device is highly adaptable according to the Anatomy of the patient wearing the device and is provided with comfortable and flexible positioning means to apply the device to a patient's body. Likewise, as the unit device motor is, at least in part, arranged in the positioning means, the device remains compact and comfortable from the point of view of a patient. Surprisingly, put the motor mechanism of the device in the positioning means no damages the functionality of the motor mechanism or the means positioners By arranging the motor mechanism of the device in the positioning means, at least in part, still allows the device induce a series of different passive movements of the member driven by the engine. Also, although the media positioners are arranged with at least one part the engine mechanism, still effectively positions the device in the body of a person carrying the device. Also, like that device according to the invention is portable, the possibilities of movement of a patient carrying the device do not look Restricted

Other objects and advantages of the present invention will be revealed by the following detailed description taken in combination with the accompanying drawings.

Detailed description of the figures

Figure 1 represents a plan view upper of the basic geometry of the lower and upper arm of a body. The two movement control points are located near the wrist and near the elbow.

Figure 2 is a front view of two basic geometries of the lower and upper arm of a body human during the movement of adduction or abduction.

Figure 3 is a top plan view of the Basic geometry of the lower and upper arm during rotation out and in.

Figure 4 is a schematic view of some of the basic components of a portable device according to a embodiment of the present invention.

Figure 5 represents a schematic view of some of the basic components of a portable device according to Another embodiment of the present invention.

Figure 6 provides a representation three-dimensional of a portable device according to another embodiment of the invention, comprising a lower arm support, a upper arm support, a motor mechanism and means positioners with a fastening belt.

Figure 7 represents a detailed view of a lower arm support according to an embodiment of the invention with arm bras.

Figure 8 is an exploded view of the mechanism motor of a device according to an embodiment of the present invention, which comprises an articulator mechanism interface that It includes a sliding motor unit arranged in a housing. The mechanical interface is attached to a subframe secondary and to the motor units, which are incorporated by less in part in a bellows structure. This mechanical interface articulator is coupled to one of the motor units.

Figure 9 illustrates the translation movement driven by the engine, according to an embodiment of the invention, as indicated by arrow 17, and the rotational movements towards in and out, not driven by the engine, as depicted with arrow 18.

Figure 10 represents a device according to a embodiment of the invention provided with a control unit a distance and two connectors on the top of the camera air, one for a transformer or batteries and another for the command to distance.

Detailed description of the invention

The present invention will be described in relation to particular embodiments and with reference to certain drawings, but the invention is not limited to these, but only by claims. The drawings described are only schematic and not limiting In the drawings, the size of any of the elements may be exaggerated or distorted and not drawn to scale, at the end of illustrative. Where the term "understanding" is used in the present description and the claims are not excluded Other elements or steps. When an indefinite article is used or defined with reference to a singular name, e.g., "a" or "the", a plural of that name is included, to unless something else is expressly indicated.

It is often necessary for specialists orthopedics hold one or more members of a human patient or animal against its movement as a result of an injury or a Treatment of the member or members. In addition, the processes that involve surgery of a limb require immobilization post-surgical, which facilitates recovery and It helps prevent complications during the recovery period. However, in addition, the injured member also needs to perform some movements, in order to strengthen your muscles and facilitate your rehabilitation. The present invention provides a device that It satisfies both requirements.

The device of the invention is applied to the distal end of a member. More specifically, when used in one arm, e.g., for movement of the shoulder and / or arm, the device is applied to the lower arm. The distal end of a member is a lower arm in case the member is a arm, and a lower leg comprising the shin and the calf in case the member is a leg. An extreme The proximal limb is an upper arm in the event that the member be an upper arm and leg or thigh in the event that The member is a leg. The harness supports the distal end of the member.

The invention relates to a device that facilitates the recovery and rehabilitation of one or more members and / or together after injuries, ailments, surgical operations or other problems In particular, the device can be used to impose a continued passive movement, "CPM", to a member and / or a meeting. CPM is defined as a continuous mechanical stimulation of the movement of a board and / or a member, in consideration of the tolerable movement of a patient. The term "passive" is refers to the absence of active participation of the patient in the movement.

It has been seen that passive motion therapy Continuous produces beneficial effects in the rehabilitation of injured members. CPM improves tendon healing and ligaments, promotes the metabolism of a joint, improves effusion resorption and can prevent and even overcome longness of a joint, as well as secondary osteoarthritis, muscular atrophy and soft tissue contracture. CPM preferably provides to a patient an anatomically correct movement that it essentially doubles the normal rhythm of the affected joint. He Passive movement is also used to treat other bone and muscle conditions, such as arthritis and dystrophy muscular.

In the description that will follow, the device according to the invention will be described in relation to its application to provide CPM to an injured shoulder and a supportive arm of that, but the present invention is not limited thereto. Is obtained a continuous mechanical stimulation of the movement of the joints, in this case an elbow and shoulder joint in consideration of movement tolerable of a patient. However, as should be understood by the invention, the application of the device according to the invention is not Limit it.

The device allows the arm and shoulder with the harness, even if they are immobilized, perform a certain number of different types of passive and automated arm movements. This device provides especially effective rehabilitation. of shoulder and arm injuries. Shorten the time of rehabilitation in general and reduces hospital care time and the treatment time, which is an important economic factor. The present invention provides a device that allows the shortening the treatment period of an injured shoulder, avoiding the stiffness of the joint and keeping the movement effective of the board.

The device according to the invention is applied against the lateral part of the torso under a patient's shoulder carrier of the device and provides support for the upper arm and the lower arm or forearm. Importantly, the device allows the arm and shoulder with the harness to perform the maximum possibility of arm and shoulder movements in a wide variety of angles and planes. As will be understood, the angles and the linear displacements of the arm and shoulder will depend on the Ergonomic limitations of each particular patient.

Figure 1 shows a basic geometry. of an upper arm (25) and a lower arm (26). As a point of heading for mechanical arm support system and concept of movement in general, the position of the elbow comprises an angle between the lower arm and the upper arm of 90º or less. The lower arm position is within a plane horizontal, which in the following will be called "horizontal plane neutral ". The neutral position of the arm, viewed from above as represented in figure 1, may consist of a position of the upper arm of about 40º in relation to the shoulder line and a position of the elbow with an angle of about 90º in relation to the shoulder.

The device according to the invention allows different types of movement are performed by the arm and the shoulder. All movements can become displacements linear The motor mechanism of the invention fulfills this condition, regardless of the ergonomic group. The mechanism that is part of the device and allows the passive movement action to be it relates to two of the "movement control points". The "motion control points", which here also called "control points", they are located in the part of the arm lower mechanical arm support and comprise a point of control of wrist 1 and a control point of elbow 2. The exact situation of checkpoints is not critical and has no why be exactly below the member's board. Thus, the wrist control point (1) can be placed near the fingers, under the palm of the hand or closer to the control point of the elbow. Hereinafter, those movement control points, according to will be described here, they will be mentioned as "control point of the wrist "and" control point of the elbow ".

The different movements of an arm that contemplated according to the present invention can be described as follows:

A first type of movement comprises that of the abduction and adduction. "Abduction" and "adduction" allude to the approach and separation movement of an arm with respect to to the middle axis or long axis, of the middle plane of the body. The "plane middle "of the body is defined by the front or rear of the body in a straight position. "Abduction" is the movement away from the middle axis, such as lifting an arm laterally or to the flanks. "Adduction" is the opposite movement, that is, the movement towards the middle axis of the body. Adduction and abduction are defined here as the parallel movement of the two control points. According to invention, adduction and abduction, that is, movement glenohumeral, can be performed according to a wide range of angles, that is, between a small starting angle, among others determined by the thickness of the portable device, and an angle final, determined by clinical relevance. That range can go technically up to at least 90º, but preferably it is between a starting angle of 10º and up to a final angle of 70º, which It is, in most cases, the clinically important range. An example of the abduction or adduction movement is indicated in the Figure 2, showing two arm positions during movement of adduction or abduction of a person's arm. In the adduction and abduction movements, the lower arm (26) moves towards or away from the body, while the lower arm (26) it remains in a substantially horizontal position, since both lower arm control points are subject to movement parallel.

A second type of movement includes rotation of the wrist (1) and the elbow (2). During wrist rotation the control point of the elbow is immobilized and the control point of the wrist moves up and down relative to the plane neutral horizontal It should be noted that this movement does not influence the wrist joint, and the expression "wrist rotation" refers to the rotation of the lower arm (26) so that the rotation the control point located near or is produced by the movement on the wrist (1). The wrist joint is not dragged on that movement, since the hand and lower arm are immobilized together on a lower arm support. During the turn of the elbow, the wrist control point is immobilized and the point of elbow control (2) goes up and down with respect to the horizontal plane neutral. The degrees of the turning movement are between anatomically important angles, e.g., between about 30º per above and about 30º below in relation to the horizontal plane neutral. The above angles are also determined by the anatomy. specific and the user's clinical circumstances. The rotation movements are produced by a linear displacement of one of the control points by an actuator or actuators appropriate, and will be in the range of 250 mm and 300 mm. For example, when the neutral position of the lower arm is fixed on the horizontal (0º), the wrist control point of the lower arm can move 30º up and 30º down in relation to the plane medium horizontal, the elbow / shoulder axis acting as a hinge.

A third type of movement comprises a combined wrist and elbow movement, alternating displacement of the two control points with respect to the middle horizontal plane. He wrist movement and elbow movement occur at the same time, but in opposite directions. For this movement combined, the virtual pivot point is located in the middle of the arm lower. The maximum deflection can vary between about 40º and about 60º, depending on the anatomy of the user's human body and the Relevant clinical motions in correspondence with the lesion.

A fourth type of movement involves the turning movements outward and inward, that is, the forward and reverse movement (see figure 3). The terms "external turn" or "exo turn" or "retropulsion" is they use synonyms here and refer to a turn separating from the middle axis of the body. The terms "internal turn" or "endo turn "or" antepulsion "are used as synonyms here and they refer to the rotation towards the middle axis of the body. These movements they take place in parallel with the neutral horizontal plane. In others words, exo turn and endo turn refer to the rotation movement around the longitudinal axis of the bone at the proximal end of the member, respectively moving away or approaching the center of the body, turning the proximal end of the limb respectively out or in. The movement of endo / exo rotation will be induced by a linear displacement of up to 300 mm An illustration of the movement of endo / exo rotation of one arm. Two arm positions are shown during the endo / exo turning movement. The angle between the arm upper and lower arm mechanically interlocks during the endo / exo turning movement. If the upper arm and the arm lower are not mechanically interlocked, that is, if the angle between the upper arm and the lower arm is allowed to vary, the same linear displacement of up to 300 mm can cause the movement of lower arm movement.

A patient can perform a series of such arm movements, which can be adjusted in terms of type of movement, the alteration of movements and their speed. Importantly, according to the device of the invention the gasket of the shoulder does not have a mechanical joint or other type of support. The type of movement that a patient must perform can be programmed, due to the use of a programmable motor mechanism. Unexpectedly, simple movements or combined when a device according to the invention is used. Though the drives described above include very moving movements different, both translation and rotation, these can optionally performed using a device of the invention driven by actuator means as a motor mechanism. Also, the degree of movement can be adjusted by the mechanism motor, e.g., by means of a control unit that can be fixed or adjust to make the drive means perform Some degree of movement. In addition, they are not imposed on the patient extreme movements Such extreme movements can cause more harm that benefit. Importantly, as they are optionally driven by a motor, all movements can be performed in controlled way and the patient can stop the movement Automatic at any time.

Figures 4 and 5 give a representation schematic of two embodiments of the present invention. Be shows a device that has two actuators (30) one of the which is at least connected to actuator means or a unit driver that ensures linear extension, also called vertical, of (at least one) actuator (30). The engine can be a part of a programmable motor (31). The actuators (30) are connected to a secondary subframe (15). This one can be attached directly to a primary subframe that supports the lower arm (3) as shown in figure 4 or alternatively, it can be attached to a primary sub-frame that supports the lower arm (3) through a mechanical interface (14), as shown in Figure 5. The two junction points between the actuators (30) and the sub-frame (15) secondary represent the two lower arm control points (26): linear movements performed by the actuators (30) are also performed by the arm bottom (26) that is immobilized on the support (3). Similarly, if the connection between the subframe secondary and the primary subframe that supports the lower arm is made by means of a mechanical interface (14), the movements of the wrist control point (1) and the point of elbow control (2) are transferred from the sub-frame secondary to the arm support lower. The actuators (30) can each be immobilized, leading to rotation of the lower arm (26) if the other actuator (30) extends, or its length is reduced, or they can be allowed to move in parallel with each other (30), leading to a horizontal movement of the secondary subframe (fifteen).

According to a particular embodiment of the invention, The motor has two drive units, attached to an actuator (30) and driving its movement. For example, in that embodiment a drive unit ensures the movement of the control point of the wrist and the other unit ensures control point movement Of elbow.

Each of the driving units ensures a actuator movement (30), that is, extension along the actuator shaft (30), allowing various types of movements.

A parallel movement of the secondary sub-frame and therefore the arm  lower when both actuators are also varied from Length at the same time. This corresponds to the movements of abduction and adduction of the arm. When you move only one of the actuators, a rotation movement of the lower arm is obtained, corresponding to the rotation of the wrist (1) or elbow (2) as It has been explained before. In order to allow a rotation of about 30º up and about 30º down from the horizontal plane neutral, the resting position of the lower arm (26) is preferably such that the length of the actuators (30) is in somewhere in the middle of its fully extended length so that the length of the actuator can be reduced, corresponding to a rotation movement down and extend, corresponding with a rotation movement up. Alternatively, if considered clinically important, that rotational movement can also be done in another way: when the rest position of the arm is fixed in the corresponding position with both actuators (30) being at its minimum (or maximum) length, a rotation about 60º extending (or reducing the length of) one of the actuators (30). The third type of movement described above, which is a combined wrist movement and elbow, is obtained when both actuators are used at the same time with their varied lengths in opposite directions.

Alternatively, it can be contemplated within the context of the invention that only one of the actuators (30) is motorized. According to this embodiment, the movements of abduction / adduction is ensured by allowing the control point non-motorized move in parallel with the control point motorized. The turning movements in such a device are ensured setting the non-motorized control point at a certain point while the motorized control point actuator moves towards up and down.

According to another embodiment of the invention, the device comprises a first subframe primary to support the distal end of the limb and a secondary subframe, and a third is arranged motor unit in the mechanical interface (14), under the first primary subframe. That third driving unit ensures the movement of the lower arm support in the direction of its longitudinal axis, as indicated by arrow 17 of the figure 9. This movement ensures the translational movement of the arm lower, which, in combination with a rotation movement around the elbow control point, allows rotation exo / endo.

The device of the invention can be attached to the member, e.g., to the arm, by means of a harness. The harness can further comprise a support (3) of the lower arm to support the lower arm of a user, also an upper arm support (4) to support a user's upper arm. The support of lower arm is coupled to the support (4) of the upper arm by a joint (5).

Flexible positioning means can be used to place the harness and drive unit on the body of a person carrying the device in a stable position. By for example, the positioning means (7) can be a housing inflatable of a flexible material provided with means (12) of fastening to a hip (figure 6). Such accommodation allows for less a partial deformation when held on a body to ensure a stable position. Due to its specific configuration, the device has the advantage of not slipping with respect to its optimal position at the back of the human body, inconvenient that appears on many of the known computers in the previous state of The technique.

Figures 6 and 7 provide an illustration more detailed of an embodiment of the device according to the invention, illustrated here for use on one arm. The device according to the invention immobilizes the upper arm (25) and the arm bottom (26) by means of an adjustable mechanical support system, comprising a lower arm support (3) and an arm support upper (4), each provided with a subframe primary and arm fasteners (10). Two simple structures made of a suitable material, such as plastic, support the arm upper and lower. A simple frame made of a material appropriate, such as metal, preferably aluminum, a compound reinforced with glass fibers, etc., supports the structures of plastic support, that is, the "sub-racks primary. "The angle between the lower arm (26) and the arm Upper (25) is controlled by mechanical articulation (5). That joint is located geometrically under the elbow of the patient. The mechanical joint can be adjusted continuously and interlock mechanically. Arranging the point of articulation mechanical under the elbow prevents physical contact with the elbow and as well as injuries that could occur due to contact physical with the elbow. The harness lower arm support is thus provided with a first primary subframe (3) and two arm fasteners (10); and upper arm support is provided with a second primary subframe (4) and a bra (10) of the arm. In what will follow, as for mechanical movement of the device, when the primary subframe, the primary sub-frame of the lower arm.

In some cases, the arm bras (10) they are provided with flexible bands or straps (12). These allow a better immobilization of the member. According to a particular embodiment of the invention, the lower arm support is also provided with a hand support cushion (13), located in The end of the stand. This support (13) of the hand prevents tension points in the tissues of the patient's arm. The arm support (13) and hand support cushion (13) They provide support for the wrist and hand. With it the hand of the patient will not be hanging, which can cause discomfort, damage or loss of circulation.

In another preferred embodiment, the portable device according to the invention comprises a device in which the support (3) of the lower arm is adjustable in order to adapt to the length of the upper arm and the lower arm of the user. The group for which the device of the invention is used consists mainly of adult men and women of 5% to 95% of ergonomic groups. Accordingly, it is preferable that the device of the invention be adjustable for each such patient. Several aspects of the device allow independent adjustment and harness customization. For example, the arm elements are fixed on the plastic support structures by means of simple belts (12). The plastic support structures can be adjusted in position to fit the upper and lower arm. The position of the hand support relative to the lower arm support can be adjusted in the direction of length. As a consequence, the device is comfortable from the patient's point of view and easy to apply. Additionally, the arm and shoulder harness is adjustable to the patient's size, body and anatomy and adaptable to the speed of movement. All these features allow the device of the invention to be independently adjustable for use with each shoulder. Likewise, as mentioned before, the positioning means of the device consist of an inflatable hollow body made of a flexible material provided with means for fastening to a thigh, eg a belt, said housing allowing its at least partial deformation when It is attached to a human body to provide a stable position. Optionally, in another embodiment, the portable device according to the invention may further comprise straps provided with fasteners. The weight of the arm and all the mechanical equipment of the device itself is supported by the positioning means, eg, an inflatable air chamber (7). The inflatable air chamber (7) is held in place in relation to the patient's body by means of a strap attached to a thigh and optional straps with simple fasteners, eg Velcro . The fact that the positioning means are made of a flexible material implies several advantages. The positioning means are deformable under the weight of the harness and the motor mechanism attached to it. Likewise, they can easily adapt to the anatomy of a patient carrying the device. In addition, it can not adopt a comfortable position along the torso of a patient carrying the device.

According to a particular embodiment of the invention, the mechanism responsible for the movement of control points may comprise a secondary subframe (15) and two driving units. The "sub-frame" secondary (15) is defined as the frame that links the point of wrist control (1) and elbow control point (2). Using this mechanism you can perform different types of movements:

a) if the two control points move in parallel, an adduction / abduction movement is performed
ction;

b) if only one of the two points is moved of control there is a rotation of only the wrist or only the elbow. For the rotation of only the wrist the control point is immobilized at the elbow and the checkpoint moves on the wrist. Should Note that this does not allow you to exercise the wrist joint (1), since the hand and the lower arm are immobilized together. This movement implies a turn on the elbow (2). Elbow rotation (2) only occurs by immobilizing the wrist control point (1) and moving the control point at the elbow (2);

c) if the wrist (1) and elbow (2) move to same time, but in opposite directions, this is called movement complex rotation of the wrist (1) and elbow (2). The mechanism actuator that allows the movement of control points preferably located in the area between the mechanical support of the arm, that is, the primary sub-frames with plastic support structures, and the air chamber, as indicated in figure 6. In another embodiment, the secondary subframe that links the two points of control involves a mechanical transition (14) to a primary subframe. The union between the secondary subframe and the primary subframe is secured by the interface mechanical (14) which is, for example, a hinge-like structure along the vertical axis, located on the patient's elbow. In the Figure 7 shows a representation of an embodiment in which the lower arm support is connected by a mechanical interface to a secondary subframe. The motor mechanism used to ensure abduction / adduction movements and rotation by the device of the present invention can be any type of mechanism that allows a controllable movement of The two control points. That motion control can be carried out, for example, by a set of inflatable air chambers, in that two separate air chambers can allow the movement of The two control points. In this case you need a pump or a air compressor in combination with inflatable air chambers separate or with air pressure cylinders. Alternatively, the controllable movement of the two control points can be performed by means of spindles, linear actuators or mechanical assemblies with cylinders Preferably this is done using spindles. driven by a drive unit formed by an electric motor that allows vertical movements of the actuators 30. Preferably two drive units are arranged in the motor mechanism, thereby a motor unit is placed for the control wrist point of movement and the other unit is arranged for the elbow point of Movement control. The two driving units induce movements in a vertical direction That vertical direction refers to the axial direction of the motor unit, as can be seen in figure 6 and in Figure 8, not a, eg, the median axis of the body. In a particular embodiment, the invention relates to a device portable, in which the first and second motor units consist in a triple spindle with electric motor with wheel transfer screw, being arranged in a housing, allowing drive units induce a vertical movement of the actuators (30). The parallel extension of the two driving units in this case allows to perform an adduction / abduction movement, while that the extension of only one drive or an unequal drive or not equivalent extension of the two driving units allows to perform rotation movements The power of the engines used is adjust so that they can provide enough power to allow vertical movement of actuators that extend under the pressure of the member resting on the units motor.

In another preferred embodiment, the motor mechanism of the invention is at least partly arranged in a structure of protection, for example, a bellows structure. The structure protective not only protects the drive mechanism, but provides protection for the harness user against being damaged by the mechanism. For the sake of security, it is an advantage for the CPM device that is designed so that it is exposed Only a minimum of the drive mechanism. If the parts are hidden functionalities of the device and in the present invention are even partially arranged in the air chamber element, it is reduced the risk of a patient being pinched by a part of the machine, or that foreign bodies, such as sheets or pieces of dress are caught in the mechanism. The bellows structure is preferably builds based on a lightweight plastic. How I know will understand, the part of the engine mechanism not provided with that protective structure is placed within the means positioners

In another embodiment, the portable device it also comprises a safety device so that the movement stops if a patient uses their muscles to counteract the movement, e.g., if the movement produces a strong pain. Opposing resistance to movement leads to a pair increased engine. The perception of increased torque in the engine It can be used to operate the safety device.

As stated before, the device of the invention may optionally further comprise an interface mechanic that makes the secondary sub-frame interact with the primary subframe of the bracket of the lower arm. In a preferred embodiment, the interface mechanic is provided with a sliding mechanism actuated by engine, said mechanism protecting the lower arm support to perform a sliding movement. If you loosen the mechanical interlocking of the joint (5) between the arm upper and lower arm, this allows a translation of the arm lower, which varies the angle between the upper arm and the lower arm In this way, the translation operated by lower arm motor. Preferably, the mechanical interface 14 It is a hinge type structure, which is located on the patient's elbow between the primary and secondary subframe.

The hinge type structure optionally allows the rotation of the primary subframe. So you can conceive that the joint allows the primary subframe is fixed parallel to the secondary subframe (15) or spin a fixed angle with the elbow control point as the center of rotation or be placed as a rotating joint.

With a fixed angle between the lower arm (26) and the upper arm (25), that is, when the joint (5) enters the lower arm and the upper arm is mechanically locked, the sliding movement of the arm induced by the mechanism motor-driven slide induces a rotation around the elbow control point, which leads to a rotation movement exo / endo arm and shoulder. Thus, the sliding mechanism motor driven combined with mechanical hinge interface Swivel allows exo / endo arm rotation movement and shoulder.

The engine arranged for the sliding mechanism It can be of any type of motor that allows movement sliding lower arm (26). The engine is preferably Light and quiet and can stop at any point. From Preferably, the motor is a triple spindle with electric motor.

An embodiment is shown in Figure 8 particular of the motor mechanism according to the present invention. The motorized sliding mechanism is placed in a accommodation (14) and connects, by means of a secondary subframe (15), with the point of elbow control (2). A bellows structure can be arranged (6) to protect the motor mechanism and to improve the safety of the harness user. There is a drive unit that controls the wrist movement (8) and another drive unit (9) controls the elbow movement. In addition, at the height of the thigh is available optionally a foam block (16). This block provides a additional mechanical protection for a user of the device according to the invention and also provides protection for the unit of device air chamber. The foam block prevents points of tension in the user's body, which could be caused by the contact of the body with the device according to the invention. Figure 5 shows the mechanical concept of the endo / exo rotation sliding mechanism, and that figure presents a detailed view of the relationship between the sliding movement of the lower arm (17) and the rotation movement (18) compensator during exo / endo rotation. The sliding mechanism, that is, the driving the lower arm support (3) according to arrow 17, it combines with a rotation point near the height of the point of the motion control elbow, according to arrow 18.

In a particular embodiment, the units motor control points near the wrist (1) and elbow (2) consist of a triple spindle with electric motor, which They are mounted in a plastic housing. The driving units they have compact electric motors with wheel transfer of screw. This concept allows controlled movements that are They can stop at any point. In addition, the spindles with electric motors have the advantage that they are completely Quiet, relatively cheap and device speed easily controllable Therefore, the device of the invention allows member movements to be carried out in a way controllable and preferably automated.

According to another embodiment of the invention, a part of the driven mechanism is located in the space that defines the envelope of the positioning means (7), e.g. a camera of air, as indicated in figure 6. The result is a device very compact Surprisingly, this provision does not prevent functionality of the positioning means (7), that is, a function air chamber support and shock absorber. The movements linear control points, in the case of movements alternatives, that is, combined movements, produce a marked angular deviation (rotation) of the motor mechanism. This is will compensate with a flexible suspension of the motor mechanism in the air chamber, without compromising the function of the camera itself. In other words, the angular deviation will be in the end in part compensated for steering flexibility, since it is mounted floating in flexible positioning means. More concretely, the engine is attached to the inflatable air chamber in the part top of the latter, that is, where the engine protrudes from the air chamber. Like the engine is not attached to the bottom or the sides of the inflatable air chamber and the latter is a flexible medium, this allows a degree of flexibility in the angle of the motor with respect to the vertical axis of the body. In addition, the union of the vertical motor extension units with the frame attached the lower arm is preferably performed using accessories of adjustable balls with a limited degree of freedom.

In a preferred embodiment, the device according to the invention further comprises a control unit a distance. The unit (19) is compact, comprising switches of control and a data display screen, for example, but without limitation, an LCD screen, and can be connected by means of a electric cable. Preferably, the medical staff determines the maximum margin of abduction / adduction or rotation with which you must Exercise your injured shoulder. The limits of these degrees of movement are introduced into a microprocessor of the control unit from distance. The control unit is designed to operate with a manual or automatic mode selection, patient controlled by means of switches of the control unit. In a mode automatic, used for continuous passive movement, the unit control continuously operates the drive unit to perform the desired movements for the arm and shoulder between The default limits. Thus, in automatic mode the shoulder can perform safely and continuously passive movements scheduled. In addition, the device according to the invention is provided with two compact connectors (20) (21), arranged in the upper part of the positioning means (7), of so that a connector is connected to the control unit (19) to distance and the other connector is attached to an electrical transformer (28) or batteries (27). In the camera's electrical interface Optional batteries can be connected to the air. Those batteries provide a minimum of autonomy in the event that it is not available of a power supply voltage. In the other case it is used a compact transformer Consequently, the arm harness and the shoulder according to the invention is designed in such a way that it allows a sufficient autonomy for the device.

In addition to anatomy adjustability individual patient, another important feature includes the fact that the device is built in such a way that, with in order to easily adapt to your employment with a member right or left, that is, for example, for use on the shoulder right or for the left shoulder. The flexible immobilization of left arm can be done in the same conditions and so symmetrical for the right arm. The following aspects allow that use of the right and left arm. The supports of plastic that support the upper and lower arms and the primary sub-racks located below have a symmetric design Also, the point of articulation of the elbow rotates so that the device is adjustable for the left arm what Same as for the right. In addition, all other interfaces are build symmetrically or allow an easy adjustment for your employment to right or left.

As stated before, the device is lightweight and portable This aspect allows the device to move from one room to another in order to allow different Patients can participate in the use of the CPM device. It is also another advantage that the device is designed to allow the patient to carry and transport it, since the patient can undergo continued treatment. The patient It can thus continue with mobility while undergoing treatment PCM This facilitates the treatment, which can last several hours or more for each session. Another aspect is that the arm harness and The shoulder is usable in all circumstances of the day and can be used immediately after an operation, even before that the user has regained his consciousness after the intervention. Since it is important that the device is portable, both from the view that it may be taken from room to room in a hospital, as it is an advantage to have a device which allows a certain amount of mobility for its user, the Device is designed to be as light as possible. So, While possible, parts such as lower arm brackets and superior, and the bellows structure that hides the mechanism actuator are constructed of lightweight materials, preferably of a rigid and light plastic. In addition, also from a point of view Ergonomic, the device of the invention has several innovative features Importantly, the device avoid the presence of any support, that is, points of tension, at or near the injured shoulder. The arm harness and shoulder involves support structures that do not originate "pressure points." Among such structures are the thigh, hand and arm brackets, hand cushion and camera inflatable air. Also, the handheld device holder is parallel to the lower arm, which is important from the point of Ergonomic view, as it prevents the hand from hanging and damages the hand and wrist, which could result in poor circulation of blood or edema In addition, the device is equipped with several Straps, which are easy and unambiguous to use. By way of important, those straps do not cross breasts, which can sometimes be painful The specific features of the device, combined with the straps, make it possible to use the equipment without slide it out of the user's back, well known problem for various devices used in the previous state of the technique.

In another embodiment, the invention relates to with the use of the portable device according to the invention for its medical application In particular, the invention relates to the use of the portable device for orthopedic treatment is injuries of arms and shoulders. The use of the device can be seen as follow. The equipment is adjusted for a specific user. Later activates the device for continued movement of the shoulder of the user, producing both abduction and adduction as well as rotation. The appropriate duration of treatment periods should Be determined by medical staff. The machine can be used also while the user is asleep.

The many advantages and features Innovative harness for arm and shoulder according to the invention make that the device is especially suitable for use in Paramedic and orthopedic applications.

Although the invention has been explained and described in relation to a particular embodiment thereof, this is a purposes of illustration rather than limitation, and within the field of the invention may fall other variations and modifications of the concrete embodiment shown and described here, as defined in the appended claims.

Claims (18)

1. Portable device suitable for provide a continuous passive movement of a member, which understands

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a harness to support a distal end (26) of the member;

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a actuator mechanism to provide continuous passive motion and adjustable of the member, said mechanism being coupled to the harness and controlling the movement of said distal end (26) of the member,

characterized because

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saying passive movement is independently controlled in a first control point of the distal end (26) of the member and a second control point at said distal end (26) of the member, and said actuator mechanism comprises at least a first unit for control the movement of said first control point of said distal end (26) of the member.

2. Portable device according to claim 1, in which the drive mechanism further comprises a second unit to control the movement of said second point of control of said distal end (26) of the member. 3. Portable device according to claim 1, further comprising means for immobilizing said second point for controlling said distal end (26) of the member. 4. Portable device according to any one of the preceding claims, wherein said device portable also includes flexible positioning means (7) provided with fastening means to position the harness and mechanism actuator in the body of a patient carrying the device in a stable position, so that the drive mechanism is by at least partly housed within the positioning means (7). 5. Portable device according to any one of the preceding claims, wherein said mechanism actuator to provide an adjustable continuous passive movement The member's is a programmable motor (31). 6. Portable device according to any one of the preceding claims, wherein the harness comprises

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a support for said distal end (26) of the member comprising a first primary subframe (3) to support the distal end (26) of the limb,

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a support for said proximal end (25) of the member comprising a second primary subframe (4) to support said proximal end (25) of the member,

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a joint (5) to connect said distal end support (26) of the member to said support of the proximal end (25) of the member.

7. Portable device according to any one of the preceding claims, wherein the harness comprises

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a secondary subframe (15) connected to the first primary subframe (3) that supports said distal end (26) of the member by means of a mechanical interface (14), linking said secondary subframe (15) the first control point with said second control point, Y

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saying mechanical interface (14) is disposed near a joint between said distal end and said proximal end (25) of the member and connecting the secondary subframe (15) with the primary subframe (3) of said distal end (26) of the member.

8. Portable device according to any one of claims 4 to 7, wherein the positioning means (7) they comprise an inflatable housing of a flexible material provided of fastening means, allowing said housing at least a partial deformation when attached to a human body to Provide a stable position. 9. Portable device according to any one of the preceding claims, wherein said support of the distal end (26) of the harness member is further provided with a bra (10) of the member, and because said end support proximal (25) of the harness member is also provided with a bra (10) of the member. 10. Portable device according to claim 9, wherein said fasteners for the distal end (26) and the proximal end (25) of the member comprise straps (12) of fixation. 11. Portable device according to any one of the preceding claims, wherein said support of said distal end (26) of the member is adjustable in order to adapt to the length of the distal end (26) of the user member. 12. Portable device according to any one of claims 2 to 11, wherein the first and second drive unit sews on a triple spindle with an electric motor and screw wheel transfer, being arranged in a housing that allows the drive units to induce a virtually vertical movement. 13. Portable device according to any one of claims 7 to 12, wherein the mechanical interface (14) It is provided with a motorized sliding mechanism, allowing said mechanism the distal end support (26) of the member for perform a sliding movement. 14. Portable device according to any one of claims 4 to 13, wherein the positioning means (7) They also include straps with fasteners, for position the device on a human body. 15. Portable device according to any one of the preceding claims, further comprising a unit remote control (19) to control passive movements provided by the device. 16. Portable device according to claim 15, wherein the remote control unit (19) comprises control switches and a visual display screen. 17. Portable device according to any one of the preceding claims, further comprising two connectors (20) (21) arranged on the top of the device, so that a connector is connected to the control unit (19) to distance and the other connector is connected to a transformer electric (28) or one or more batteries (27). 18. Portable device according to any one of the preceding claims, wherein the passive movements of the member provided by the device are made of a automated way.